Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

What is Delirium?

Delirium is a medical word used to describe the condition that causes a sick person to become confused in his or her thinking. This is a physical problem, not a psychological one. Delirium usually comes on over a few days and, with treatment, it will often improve.

What Causes Delirium?

A physical illness can cause delirium, particularly if there are changes in the chemistry of the blood, or if dehydration or infection exist. Medications, although necessary to treat illness or provide pain control and symptom relief, also may contribute to the development of delirium. Anyone can become delirious under certain circumstances of illness.

What Are the Signs and Symptoms of Delirium?

A sick person may show some or all of the following symptoms of delirium:

Saying things that are all mixed up;

Not knowing where they are;

Seeing or hearing things which are not real;

Being restless and unable to stay still;

Climbing out of bed; and

Having restless spells that alternate with being drowsy and sleepier than usual.

The sick person may seem irritable and angry. They may not be able to understand when people try to reassure them that everything is all right. They also may be irritable with nurses and other staff. They may be somewhat paranoid and suspicious, thinking that everyone is against them or that there is a plot going on. Some delirious people may want to call the police to get help.

One of the best ways to understand delirium, and what a delirious sick person is going through, is to imagine what it is like to be in the middle of a very mixed up and strange dream or nightmare. The difference with a delirious person is that they are having these experiences while they are awake. 131

How is Delirium Treated?

First, doctors will try to find the most likely cause of the delirium. Sometimes this is a puzzle, and, often, no single cause can be pinpointed. The doctor may make changes to the medications the delirious person is taking. Treatment may also include measures like an intravenous (IV) to administer fluid that can correct chemical problems in the blood and treat infection. The doctor also will order some medications to treat the delirium itself, and may order sedatives to help the delirious person stay calm.

What Can Family and Friends Do to Help?

There are some things that you can do to help if someone you care about is going through a period of delirium when ill.

Talk with the healthcare team about any signs of delirium you see developing in your loved one.

Be reassured that, with treatment, the delirium should go away, or will be greatly reduced.

Try to use a calm, soft voice when speaking to your loved one or with others nearby.

Try placing a soft light in the room at night so your loved one can see where he or she is. Delirious people often are more restless and agitated at night because they feel disoriented.

Remind them where they are. If they are in the hospital, try placing a poster-type sign at the foot of the bed with large letters saying, for example, “You are in the ____Hospital on____ Street in ____(city).”

Remind the person of the date, time and season. This will help them stay connected.

Gently reassure them that they are safe and that everything is all right.

Consider developing a schedule of family and close friends to stay with the person around the clock so they will not be alone. This will help them feel secure and less frightened, and also will help maintain their own safety if they are restless or agitated. Sometimes hospitals have volunteers who can help with this. Some families will hire a healthcare aid for the night-time hours. This gives peace of mind to the family, and will allow you to get some needed sleep at home while knowing that your loved one is not alone.

Bring familiar photos into the room and play favourite music softly in the background.

Consider limiting the number of visitors who come to see your loved one until the delirium goes away.

Remember to look after yourself. Try to get some rest and relaxation. Go out for short walks, have a massage, or do other relaxing and restoring things. Remember to eat, drink lots of fluids to keep up your energy, and try not to drink too much coffee and other caffeinated beverages. It is not easy to be with a delirious person, even though you may understand the nature of the problem. It may help to share your thoughts and feelings with someone. Ask to see a palliative-care team, hospital chaplain or social worker for supportive counselling.

Try not to take some of the things that your loved one says to heart. Remember that delirious people are not themselves. In fact, they are not likely to remember very much about the period of time that they suffer from delirium, and they will not remember what they said, what they did, or what happened.

Prepared by Dr. Elizabeth Latimer, Professor, Department of Family Medicine, McMaster University and Palliative Care Physician, Hamilton Health Sciences. Reprinted with permission, from the author and the Canadian Journal of CME first printed in Managing Delirium in Seriously Ill and Dying Patients, Journal of CME, September 1999 (133), 91-109.